Provider Demographics
NPI:1467781872
Name:SUNDELL, MARGARET E (MA, NCTMB)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:E
Last Name:SUNDELL
Suffix:
Gender:F
Credentials:MA, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4756 BANNING AVE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3205
Mailing Address - Country:US
Mailing Address - Phone:651-653-5058
Mailing Address - Fax:952-233-2012
Practice Address - Street 1:4756 BANNING AVE
Practice Address - Street 2:SUITE 217
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3205
Practice Address - Country:US
Practice Address - Phone:651-653-5058
Practice Address - Fax:952-233-2012
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52503906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist